Individual
DR. JOHN CHRISTOPHER STACKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1551 E MULLAN AVE STE 102, POST FALLS, ID 83854-9005
(208) 262-2328
(208) 619-5057
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-2300
(208) 262-2390
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M-6239
ID
208M00000X
Hospitalist Physician
Primary
M-6239
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022315
—
WA
05
—
1922095397
—
ID
Enumeration date
09/30/2005
Last updated
12/12/2024
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